The Opportunity Cost of Healthy Behavior

By Mark J. Harris

After a long day at the office or the hospital, when I am mentally wiped out, going for a bike ride or lifting weights at the gym is often the last thing that I want to do. I also don’t want to go grocery shopping, make dinner, or plan lunch for the next day. I definitely don’t want to take the time to floss. Happy hour, sitting on the couch and watching Netflix, or trying out a new restaurant with friends sound much more appealing.

This problem is shared by all – we are constantly bombarded with messages and forced to make short-term decisions that may conflict with long-term health goals. Eat healthy, but try the KFC Double Down. Go to the gym, but have you marathon-watched that new season of House of Cards yet?

Living a “healthy” lifestyle – however defined – takes work and energy. It means extra time to make it to the grocery store (instead of ordering in), saying no to that extra drink, and being conscientious when eating out. It can have the added social side effect of making you seem uptight, judgmental, or boring.

Medicine and public health sometimes forget to consider these competing social, individual, and financial demands. In some research fields, thankfully, this blind spot is slowly shrinking. A recent study on food shopping behavior as it relates to access to supermarkets proposed the idea that “personal choices, psychosocial factors, and unobserved measures of socioeconomic status” may better predict dietary intake “than mere physical proximity” to the store.

We will make progress by lowering the barriers to change. Public health and medicine can learn from each other by combining individually directed behavior change with population-scale alterations of the social determinants of health (see image below). We can use principles of behavioral economics to promote healthy behavior. Once the opportunity cost of a healthy behavior is low enough, we will find attaining and maintaining health easier.

Mark J. Harris is a dual MD/MPH student at Columbia University. You can follow his thoughts on Twitter at @MarkMDMPH, and the Vitality Institute at @VitalityInst.

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